Apparatus for laterally x-raying the spinal column



1956 E. A. Fox 2,774,884

APPARATUS FOR LATERALLY X-RAYING THE SPINAL COLUMN Filed June 22, 1955 2 Sheets-Sheet l INVENTOR Ernest A.Fox

CLW

RNEY

Dec. 18, 1956 E. A. FOX 2,774,884

APPARATUS FOR LATERALLY X-RAYING THE SPINAL COLUMN Filed June 22, 1953 2 Sheets-Sheet 2 'FTc 5| 6 l INVENTOR 4 Ernest A. Fax

ORNEY Unite States APPARATUS FOR LATERALLY X-RAYING THE SPINAL COLUMN The present invention relates broadly to X-ray apparatus, and more specifically to an apparatus for immobilizing a patient so as to facilitate the taking of accurate lateral X-ray pictures of the spinal column.

The conventional procedure for taking routine lateral X-ray pictures of the spinal column, and particularly in the lumbar area, has been with the patient lying on his side, as is set forth in Dr. L. R. Santes Manual of Roentgenological Technique, 1936 edition, page 135, and the book of Drs. Hendricks and Rich entitled X-ray Technique and Spinal Misalignment Interpretation, 1947 edition, page 71. The development of the present invention showed that this manner of taking X-ray pictures did not give a 'true understanding of certain fundamental information which is necessary to a full and proper diagnosis since it is almost impossible to immobilize the patient in this position with present day apparatus, and further by lying on ones side the spinal column sags in a downward direction between the shoulder and hip, which is accentuated in females due to wide hip structure, thus interfering with the accuracy of the X-ray picture.

It also must be recognized that so-called back trouble is almost always most painful when standing in vertical position and particularly after having stood up or worked in that position for a considerable period of time until'the back muscles become tired and allow the spinal column to sag. In the development of the present invention it became clear that if lateral X-ray pictures of the spinal column could be taken with the patient in standing position, rather than while in either sitting or lying positions, the difficulties which cause his back trouble will be much easier to determine.

With the back out of true alinement, there are a series of major and minor nerve pressures which sap the patients strength. My work in observing thousands of cases of back trouble over a period of years and checking same with the Ellis Micro Dynometer showed that the major pressures were developed at the lumbo-sacral and occipital at-las levels, with most of the back trouble originating in the lumbo-sacral articulation. A. P. X-ray views,

menae from side to side with the patient lying on his side on the X-ray table. The information thus obtained through standard routine procedures of obtaining both the A. P. and lateral lumbar X-ray pictures has, therefore, been inaccurate and not sufficiently complete to facilitate the making of an accurate diagnosis of the trouble. This, in turn, quite commonly led to the conatent were always ready to operate on those cases which presented the symptoms of disc pathologies. In developing my present invention, which made possible for the first time accurate lateral X-ray pictures of the spinal column with the patient standing in upright position, it became apparent that instead of having disc pathologies requiring surgery what we actually were confronted with, so far as concerns lumbar area trouble, was the very common slipping forward of the fifth lumbar on its sacral base. Beyond the normal limits of slippage this is called a spondylolisthesis and is supposed to be relatively rare, and that the ordinary doctor dealing with back trouble on the average would only see about four in a lifetime. With my invention I have been able to find that many in one week.

It appears that a good share of this back trouble gets its start in the growing years between the ages of 14 and 18 when there is an apparent physical development and strength but not the stability or permanence in the osseous structures involved, especially the superior articular processes of the sacral base and the inferior articulating facets of the fifth lumbar. These opposing surfaces in the presence of too great a strain, either at one time or over a period of years, become rudimentary and weak. Later in life, on the occasion of a fall or the like, these opposing surfaces over-ride or fracture thus permitting the fifth lumbar to move forward on the sloping surface which we call the sacral base. Trouble then arises because we have lost our osseous stability and are now dependent upon the posterior spinal muscles to keep an already anterior lumbar vertebra from moving still further forward. It is the lack in the past of suitable apparatus facilitating the discovery of this difliculty and the proper diagnosing of it, which is overcome by my present invention. It was a recognition of the serious problems, shortcomings, and difliculties in this field of X-ray diagnosis, and the entire lack of any wholly satisfactory routine solution for same, which led to the conception and development of the present invention.

Accordingly among the objects of the present invention is the provision of an apparatus making it possible to immobilize a patient sufliciently long to successfully permit routine capturing by X-ray procedure the details of the spinal column, such as the lumbar bodies, discs, and interverte-bral foramena so as to facilitate an accurate diagnosis of the back condition.

Another object is to provide an apparatus making possible rapid routine study of the discs, body, foramenae, and the lumbo-sacral angle of the human spinal column with the patient standing immobilized in normal upright position during the taking of X-ray pictures.

Another object is to provide a positioner for supporting and immobilizing the patients hips and shoulders during the taking of lateral X-ray pictures of his spinal column.

Another object is to provide a positioner having an adjustable belt for helping to immobilize the patients shoulders and hips by holding them firmly againsta support member during the taking of X-ray pictures laterally through his spinal column.

Another object is to provide, as part of the present apparatus, a foot positioner to assure the proper standing position of the patient when the X-ray pictures are to be taken laterally of his spinal column.

Another object is to provide the lateral lumbar .X ray positioner assembly in the form of removable back rest apparatus which may be easily installed and removed from in front of an X-ray table, or a wall Bucky.

A further object is to provide a simple procedure for fast routine lining up the X-ray emitter, patient, and film for accurate shooting of X-rays through the desired verclusion that the patient had disc trouble, andthe surgeons tebral foramena.

A further object is to provide a light weight apparatus, the back rest portion of which is easily mounted in place and removed when other Work is to be done, is exceptionally easy to use for fast routine work, efficient, easy to manufacture, and of relatively low cost.

Still further objects and advantages of the invention will appear as the description proceeds.

To the accomplishment of the foregoing and related ends, the invention, then, consists of the X-raying means hereinafter fully described and particularly pointed out in the claims, the annexed drawings and the following description setting forth in detail certain means and modes of carrying out the invention, such disclosed means and modes illustrating, however, but several of the various ways in which the principle of the invention may be used.

In the annexed drawings:

Figure l is a front perspective assembly view showing the apparatus of the present invention mounted in operating position on a vertically tilted conventional X-ray table.

Figure 2 is a fragmentary top view of the apparatus shown in Figure 1.

Figure 3 is a sectional view showing how certain of the parts are separably joined together.

Figure 4 is front view of the Figure 3 assembly with the joined member removed to show the bolt and the bayonet slot into which the bolt head fits.

Figure 5 is a sectional view showing a modification of the assembly shown in Figure 3 and wherein a clip is used for separably fastening certain of the parts together.

Referring more particularly to Figure 1 of the drawing, it will be noted that there is a vertically tiltable X-ray table 1 pivotally mounted on legs 2, and an X-ray emitting apparatus 3 adapted to be adjustably moved to various positions meeting X-ray requirements. Mounted on the back face of the X-ray table and conventionally movable to various positions thereon is a Bucky diaphragm 4 which carries the cassette 15 with its film to be exposed during the X-raying process. While this Bucky diaphragm is shown as mounted on an Xray table, a member like this table portion with the Bucky diaphragm on it, but without legs 2, can be mounted on a wall and in that case is called a wall Bucky diaphragm. The use of a wall Bucky diaphragm does not change the present invention at all and it is intended that the showing in Figures 1 and 2 be considered to diagrammatically illustrate either of these constructions.

Mounted on the X-ray table, as by means of bolts 5 with heads fitting into bayonet slots 6, is a support assembly 7. This support assembly preferably has an extension panel 8 which extends from one edge of the X-ray table part way over the face of same with the bolts 5, or the like, joining same to the edge of the table. At the opposite edge of this extension panel from that carrying said bolts, there projects outward a back rest panel 9 substantially at right angles to said extension panel, and which is braced and anchored to same by conventional means, such as brackets iii. For convenience the outer or free edge of back rest panel 9 is provided with an extending rib member 11 on its rear face for a purpose to be hereinafter described.

Resting on the floor directly in front of the front face of the X-ray table, Figures 1 and 2, is a foot positioning assembly 12. This foot positioning assembly preferably has on its upper face a center rib 13 for sidewise spacing of the patients feet, and a back rib 14 against which the patients heels should be brought when positioning the patient for taking lateral X-rays, for instance through his spinal column. The front edge of this back rib 14 against which the patients heels contact is preferably in vertical alinement with the front edge, or back contacting portion, of panel 9 against which the patients back rests during the X-ray picture taking procedure. This plan causes the patient to stand upright in .a routine prechosen position which facilitates immobilizing him so that a very accurate, precision, and readily duplicatable X-ray picture can be taken through the vertebral foramenae of the spine in the particular area to be studied.

Adjustably mounted on the X-ray table, at the opposite edge of same from that on which the support assembly 7 is mounted, is a reel assembly 16 which carries an immobilization belt 17 and means for releasably anchoring the latter in various extended positions. The free end of this belt is provided with an elongated hook member 18 which preferably is of substantially the same width as the immobilization belt. This hook member is adapted to hook over rib member 11 on the outer back edge of back rest panel 9 to anchor the free end of the belt. This belt, when anchored to panel 9, is substantially centered on the X-ray path, as shown in Figure l, and may be made of any suitable X-ray pervious material, such as cloth, and serves two purposes when tightened by reverse movement of the rotatable portion of the reel assembly 16 and held in tightened position: first it acts as a support for stabilizing the outer edge of the support assembly 7, and second it helps to bind and immobilize the patient 19, diagrammatically shown in dashed lines in Figure 2, in proper position for the precision taking of routine lateral X-ray pictures of his spine or other portions of his body.

Since some X-ray tables may not have bayonet slots 6 in the face of the outer edge portion of same, it may be necessary to use clamps 20, Figure 5, with a thumb screw 21, or the like, for anchoring the support assembly 7 in place. In that case instead of having an opening 22, Figure 3, completely through the extension panel 8, for instance at its upper and lower corners, for the reception of bolts 5, this extension panel 8a may be provided with recesses 24 into which the end of thumb screw 21 can pass, and upon tightening such thumb screw, bind the support assembly 7 to the face of the X-ray table, or the like, carrying the Bucky diaphragm 4.

When the particular area of the patients back where trouble is anticipated, has been decided upon, for instance at the fifth lumbar area, this point on the patient is known to the roentgenologist and his next problem is to rapidly and accurately line up the X-ray emitter so as to shoot the X-rays directly through the specific vertebral foramena in question. This I have found can be accornplished quite readily and rapidly by first moving the Bucky diaphragm 4 so as to approximately center on this area, and then by stretching a cord 23 from a point on the Bucky diaphragm, at the elevation to be X-rayed on the patient, to the X-ray emitting apparatus 3, and adjusting the latter up or down until the center of the X-ray beam is such that the cord 23 is horizontal and the beam centered on the area to be X-rayed, the apparatus is ready for use. With the patient 19 standing on the foot positioning assembly 12 with his feet on opposite sides of center rib 14, and his shoulders and hips against the front or back rest face of support assembly 7, and held immobilized in that position by means of the tightened immobilization belt 17, the patient is in a position to have a lateral X-ray picture taken of his spine in a manner more accurate than any other procedure heretofore used for routine X-ray examinations. In fact this procedure makes possible the taking of a precision and duplicatable routine lateral lumbar X-ray picture in about a minute, while at best the previously used techniques have been exceedingly time consuming and relatively inaccurate at best, and very difiicult to accurately duplicate.

The most common back trouble is found in the lumbar region, but nevertheless the use of the present invention is not limited to taking lateral lumbar X-ray pictures since it is suitable for taking accurate routine X-ray pictures of various areas of the patient, and so far as the spinal column is concerned this includes the cervicals, dorsals, sacrum, and coccyx in addition to the lumbars. While fnost backtrouble can be most accurately diagnosed with the patient held immobilized in standing position, the invention again is not limited to use for taking X-ray pictures with the patient in standing position, but rather it is usable where immobilization is essential during the taking of the X-ray pictures. In some cases where the taking of X-ray pictures is necessary, the patient is unable to stand or be stood up for that purpose and under those conditions it becomes necessary to take the X-ray pictures with the patient reclining on his side. Here the inaccuracies in the X-ray photographs due to sagging of the spinal column between the shoulder and hip must be put up with if shimming under the patient in this area is not practical. However a major difiiculty in obtaining duplicatable and accurate routine X-ray pictures with the patient reclining on his side has been due to a complete lack 'of suitable apparatus for immobilizing the patient during the taking of the X-ray picture, and which has led to the makeshift procedure of stacking sand bags around the patient to hold him semi-immobilized. The present apparatus completely overcomes this difilculty since with the X-ray table moved to horizontal position, and the back rest assembly 7 with immobilizing belt 17 connected and tightened on the patient, this will immobilize him and completely overcome this previously unsolved portion.

Other modes of applying the principle of my invention may be employed instead of those explained, change being made as regards the means herein disclosed, provided those stated by any of the following claims or their equivalent be employed.

I therefore particularly point out and distinctly claim as my invention:

1. In an apparatus for taking lateral X-ray pictures of a patient or the like through the use of an X-ray emitter and a cassette carrying and supporting appara tus, the combination therewith of a support assembly, means for mounting said support assembly on said cassette carrying and supporting apparatus at the side of same facing said X-ray emitter, said support assembly having as part of same a back rest panel extending edge wise in the general direction toward said X-ray emitter, and in a plane substantially perpendicular to said cassette carrying and supporting apparatus, and means extendable between the outer edge of the edgewise extending portion of said back rest panel and the outer edge portion of said cassette carrying and supporting apparatus which is faced by said back rest panel, said extendable means being of flexible X-ray pervious material with a disengageable fastening means attachable to the outer edge of said back rest panel and a take-up means on the outer edge of said cassette carrying and supporting apparatus for tightening said flexible X-ray pervious material against a patient to be X-rayed, whereby a patient with his back up against the back rest panel and sidewise to said cassette carrying and supporting apparatus and held immobilized in that position with the aid of said means extending between said cassette carrying and supporting apparatus and the outer edge portion of said back rest panel will be in position to have satisfactory routine lateral X-ray pictures taken.

2. In an apparatus for taking lateral X-ray pictures of a patient or the like through the use of an X-ray emitter and a cassette carrying and supporting apparatus, the combination therewith of a support assembly, means for mounting said support assembly on said cassette carrying and supporting apparatus at the side of same facing said X-ray emitter, said support assembly having as part of same a back rest panel extending edgewise in the general direction toward said X-ray emitter, and in a plane substantially perpendicular to said cassette carrying and supporting apparatus, and means extendable between the outer edge of the edgewise extending portion of said back rest panel and the outer edge portion of said cassette carrying and supporting apparatus which is faced by said back rest panel, whereby a patient with his back up againstthe back rest panel and sidewise to said cassette carrying and supporting apparatus and held immobilized in that position with the aid of said means extending between said cassette carrying and supporting apparatus and the outer edge portion of said back rest panel will be in position to have satisfactory routine lateral X-ray pictures taken, wherein said means extendable between the cassette carrying and supporting apparatus and the outer end portion of said back rest panel comprises an immobilization belt with a hook means at one end for engaging the outer end portion of said back rest panel, while the other end of said belt has a reel operably connected to same, means on the outer end portion of said back rest panel adapted to be engaged by said hook means, and means for connecting said reel in operable position on said cassette carrying and supporting apparatus at the side edge of same toward which said back rest panel faces.

3. In an apparatus as set forth in claim 1, wherein said support assembly has as a part of same a back rest panel portion extending in the general direction toward said X-ray emitter, also an extension panel portion one edge of which is removably fastened to one edge portion of said cassette carrying and supporting apparatus while the portion forming the back rest of the panel is fastened to the other edge of said extension panel and projects outward therefrom at a point between the side edges of said cassette holding and supporting apparatus, and brace means at the junction of said back rest panel portion and said extension panel portion for holding same operably fastened together.

4. In an apparatus for taking lateral X-ray pictures of a patient or the like through the use of an X-ray emitter and a cassette carrying and supporting apparatus, the combination therewith of a support assembly, means mounting said support assembly on said cassette carrying and supporting apparatus at the side of same facing said X-ray emitter, said support assembly having as a part of same a back rest panel extending edgewise in the general direction toward said X-ray emitter, and in a. substantially vertical plane perpendicular to said cassette carrying and supporting apparatus, a foot positioning apparatus below and extending forward of the back rest face of said back rest panel, and means including an X- ray pervious flexible portion extendable between the outer edge of the edgewise extending portion of said back rest panel and the outer edge portion of said cassette carrying and supporting apparatus which is faced by said back rest panel, whereby a patient standing on said foot positioning apparatus with his back up against the back rest panel and sidewise to said cassette carrying and supporting apparatus and up'against same will be in a position to have satisfactory routine lateral X-ray pictures taken.

5. In an apparatus as set forth in claim 4, wherein said means extendable between the cassette carrying and supporting apparatus and the outer end portion of said back rest panel comprises as the X-ray previous flexible portion an immobilization belt member with a hook means at one end for engaging the outer end portion of said back rest panel, while the other end of said belt has a reel operably connected to same, means on the outer end portion of said back rest panel adapted to be engaged by said hood means, and means for connecting said reel in operable position on said cassette carrying and supporting apparatus at the side edge of same toward which said back rest panel faces.

6. In an apparatus as set forth in claim 4, wherein said support assembly has as a part of same a back rest panel portion extending in the general direction toward said X-ray emitter, also an extension panel portion one edge of which is removably fastened to one edge portion of said cassette carrying and supporting apparatus while the portion forming the back rest of the panel is fastened to the other edge of said extension panel and projects outward therefrom at a point between the side edges of said 7 Cassette holding and supporting apparatus, and brace means at the junction of said back rest panel portion and said extension panel for holding same operably fastened together.

7. In an apparatus for taking lateral spinal X-ray pictures through the use of an X-ray emitter and a cassette carrying and supporting apparatus, the combination therewith of a support assembly, means removably mounting said support assembly on said cassette carrying and supporting apparatus at one edge thereof and on the side of same facing said X-ray emitter, said support assembly having as part of same an extension panel, one edge of which is fastened by said means to said cassette carrying and supporting apparatus While the other edge of said extension panel has fastened to same a back rest panel extending outward substantially perpendicular to said cassette carrying and supporting apparatus and in the general direction toward said X-ray emitter, and a brace means for rigidly anchoring said back rest panel to said extension panel, a foot positioning apparatus below and extending forward of the back rest face of said back rest panel, said foot positioning apparatus having a back rib below said back rest panel forming a backstop, and an immobilization belt with a hook means at one end for engaging the outer end portion of said back rest panel, a reel operably connected to the other end of said belt for releasably holding same with prechosen tightness, and means for connecting said reel in operable position adjustably on said cassette carrying and supporting apparatus at the side edge of same toward which said back rest panel faces, whereby a patient standing on said foot positioning apparatus with 'his heels against said backstop and his side up against the cassette carrying and supporting apparatus and his back against the back rest face of the back rest panel and with said immobilization bel-t connected to the outer end of said back rest panel and tightened against the patient by means of said reel, will be in position to have a lateral X-ray picture taken of his spinal column.

8. In an apparatus as set forth in claim 7, the combination therewith of a cord extendable at desired elevation between said cassette carrying and supporting apparatus and said X-ray emitter to facilitate quick alinement of same for the taking of accurate and fast routine X-ray pictures.

References Cited in the file of this patent UNITED STATES PATENTS 1,430,095 Meyer Sept. 26, 1922 1,573,571 Pohl Feb. 16, 1926 1,933,325 Goldfield et al. Oct. 31, 1933 2,264,410 Schier Dec. 2, 1941 2,568,191 Grimm Sept. 18, 1951 2,571,011 Chapman Oct. 9, 1951 

